Department of Neurosurgery, The Sixth Affiliated Hospital of Wenzhou Medical University, No. 15 Dazhong Road, Lishui, 323000, China.
Department of Neurosurgery, Lishui People's Hospital, No. 15 Dazhong Road, Lishui, 323000, China.
Neurosurg Rev. 2024 Sep 4;47(1):528. doi: 10.1007/s10143-024-02755-9.
Dickkopf-1 (DKK-1) may be involved in inflammatory response and secondary brain injury after acute brain injury. We gauged serum DKK-1 levels and further assessed its correlation with disease severity and investigated its predictive value for 90-day prognosis in patients with spontaneous intracerebral hemorrhage (sICH). Serum DKK-1 levels were measured in 128 sICH patients and 128 healthy controls. The severity of sICH was assessed using the Glasgow Coma Scale (GCS) scores and hematoma volumes. Poor prognosis was referred to as a Glasgow Outcome Scale (GOS) score of 1-3 at 90 days after stroke. Multivariate analysis was performed to identify associations of serum DKK-1 levels with disease severity, early neurological deterioration (END) and poor prognosis. Receiver operating characteristic curve (ROC) was built to investigate the prognostic predictive capability. The serum DKK-1 levels of patients were significantly higher than those of controls (median, 4.74 ng/mL versus 1.98 ng/mL; P < 0.001), and were independently correlated with hematoma volumes (ρ = 0.567, P < 0.001; t = 3.444, P = 0.001) and GCS score (ρ = -0.612, P < 0.001; t = -2.048, P = 0.043). Serum DKK-1 significantly differentiated patients at risk of END (area under ROC curve (AUC), 0.850; 95% confidence interval (CI), 0.777-0.907; P < 0.001) and poor prognosis (AUC, 0.830; 95% CI, 0.753-0.890; P < 0.001), which had similar prognostic ability, as compared to GCS scores and hematoma volumes. Subsequent Logistic regression model affirmed that GCS score, hematoma volume, and serum DKK-1 levels were independently associated with END and poor prognosis at 90 days after sICH. The models, which contained them, performed well using ROC curve analysis and calibration curve analysis. Serum DKK-1 levels are markedly associated with disease severity, END and 90-day poor prognosis in sICH. Hence, serum DKK-1 is presumed to be used as a potential prognostic biomarker of sICH.
Dickkopf-1 (DKK-1) 可能参与急性脑损伤后的炎症反应和继发性脑损伤。我们测量了血清 DKK-1 水平，并进一步评估了其与疾病严重程度的相关性，探讨了其对自发性脑出血 (sICH) 患者 90 天预后的预测价值。我们检测了 128 例 sICH 患者和 128 例健康对照者的血清 DKK-1 水平。sICH 严重程度采用格拉斯哥昏迷量表 (GCS) 评分和血肿体积进行评估。预后不良定义为脑卒中后 90 天格拉斯哥结局量表 (GOS) 评分 1-3 分。采用多变量分析确定血清 DKK-1 水平与疾病严重程度、早期神经功能恶化 (END) 和不良预后的相关性。绘制受试者工作特征曲线 (ROC) 以探讨预后预测能力。患者的血清 DKK-1 水平明显高于对照组 (中位数，4.74ng/ml 与 1.98ng/ml；P<0.001)，且与血肿体积 (ρ=0.567，P<0.001；t=3.444，P=0.001) 和 GCS 评分 (ρ=-0.612，P<0.001；t=-2.048，P=0.043) 独立相关。血清 DKK-1 可显著区分有 END 风险的患者 (ROC 曲线下面积 (AUC)，0.850；95%置信区间 (CI)，0.777-0.907；P<0.001) 和预后不良者 (AUC，0.830；95%CI，0.753-0.890；P<0.001)，与 GCS 评分和血肿体积相比，其预后能力相似。随后的 Logistic 回归模型证实，GCS 评分、血肿体积和血清 DKK-1 水平与 sICH 后 90 天的 END 和不良预后独立相关。这些模型的 ROC 曲线分析和校准曲线分析均表现良好。血清 DKK-1 水平与 sICH 患者的疾病严重程度、END 和 90 天预后不良显著相关。因此，血清 DKK-1 可能被用作 sICH 的潜在预后生物标志物。
